C M Y K
Short / Normal
DESIGN SERVICES OF
S4CARLIsLE
Publishing Services 195
152041 Cust: LWW Au: Mosca Pg. No. 195
Title: Foot Deformities and Malformations in Children and Adolescents 1e
CHAPTER
8
Bone Procedures
I. GUIDED GROWTH
Medial Distal Tibia Guided Growth with
Retrograde Medial Malleolus Screw
1. Indications
a. Pain due to lateral hindfoot impingement and/or medial
hindfoot soft tissue strain caused by exaggerated con-
genital or acquired valgus deformity of the ankle joint
(see Assessment Principles #11 and 21, Chapter 3;
Valgus Deformity of the Ankle Joint, Chapter 5 )
b. If there is coincident valgus deformity of the ankle
joint and the subtalar joint, the ankle deformity should
be corrected first (see Management Principle #23-6,
Chapter 4; Valgus Deformity of the Ankle Joint and
the Hindfoot, Chapter 5 ).
2. Technique (Figure 8-1)
a. Make a 7-mm longitudinal incision immediately distal
to the medial malleolus in the midcoronal plane of the
tibia
b. Insert a guide pin for the 4.5-mm cannulated screws ret-
rograde from the intersection of the medial-to- lateral
center of the medial malleolus with the midcoronal
plane of the tibia, using mini-fluoroscopy for guidance.
Anterior placement could result in recurvatum and
posterior placement in procurvatum.
i. Ensure placement in the midcoronal plane of the
tibia by visualizing a true lateral image of the ankle
on mini-fluoroscopy, i.e., the posterior cortex of the
fibula and the posterior cortex of the tibia are colin-
ear. Using the “dome of the talus” as the alignment
guide for a true lateral image of the ankle is unreli-
able in children because of immature ossification of
the talus and/or malformations/deformities of the
talus. The midcoronal plane of the tibia is typically
in line with the anterior cortex of the fibula.
c. Insert the guide pin parallel with, and immediately adjacent to, the medial cortex of the tibial metaphy-
sis. The more medial the screw, the mor
足踝畸形矫正.pdf